Secure Financing Application

Application Type
Type of business
Corporation Tax ID Number, if applicable

Applicant Information
First Name *
Middle Initial
Last Name *
Suffix (ie: JR.)
License # (With State + Expiration Date)
Social Security #
Date of Birth
Present Address
(Number & Street)		 *
Present Address 2
City
Country
State *
Zip Code
Time at this address? Years Months

Business Phone Number
Home Phone Number
Cell Phone Number
E-mail Address

Previous Address
(if less than 3 years at current address)
Previous Address 2
City
State
Zip Code
Time at this address? Years Months

Spouse First Name
Spouse Middle Initial
Spouse Last Name
Date of Birth
Spouse Social Security #
Spouse Occupation & Salary
Will spouse be co-signing?

Nearest relative not living with you?
Address
Phone Number
Relationship

Additional Personal Reference
Address
Phone Number
Relationship

Corporation Information
Corporation Name
Incorporated in what state?
Date of Incorporation
Date in Business

1. Principal
Principal Title
% Owned

2. Principal
Principal Title
% Owned

Employment Information
  Show at least last 2 years driving Experience
Current Employer
Contact Name
Phone
How long?
Position
Hauling What:
Options
Previous Employer
Contact Name
Phone
How long?
Position
Hauling What:
Options
Previous Employer
Contact Name
Phone
How long?
Position
Hauling What:
Options
Previous Employer
Contact Name
Phone
How long?
Position
Hauling What:
Options
Previous Employer
Contact Name
Phone
How long?
Position
Hauling What:
Options

Total Driving Experience: Years as Company Driver
Years as Owner Operator
As Owner Operator, what was the nature of business?
What was the gross monthly income?

Carrier truck will haul for:
Phone
Address
(Number & Street)
Address 2
MC#
City
State
Zip

How will equipment be used?
Miles per Year
Driver name if other than owner
Details


Have you ever taken bankrupcy?
If yes, discharge date
Have you ever had an item repossessed?
Explanation

List what you own
Cash on hand & in bank, $

Vehicle 1: Year/Make/Model
Is financed? By whom?
Estimated Value

Vehicle 2: Year/Make/Model
Is financed? By whom?
Estimated Value

Vehicle 3: Year/Make/Model
Is financed? By whom?
Estimated Value

Over the Road Truck: Year/Make/Model
Estimated Value
Is it Financed?
If yes, by whom?
Address
Phone Number
Account Number

Real Estate
Type
Mortgage Company
Address
Phone Number
Account Number
Estimated Real-Estate Value
Estimated Equity
Monthly Payment, $

2. Other Assets
Estimated Value
3. Other Assets
Estimated Value

List all Debts (except mortgage)
1. Type
Balance
Monthly Payment

2. Type
Balance
Monthly Payment

3. Type
Balance
Monthly Payment

4. Type
Balance
Monthly Payment

5. Type
Balance
Monthly Payment

6. Type
Balance
Monthly Payment

Unit Information
Replacement Unit?
If Yes, are you using a trade?
Additional Unit?
If yes, how many do you currently own or lease: Tractors; Trailers
How much money do you have to pay down? $
What is the source of your down payment or deposit?
(check all that applies)

Trade-In Description
Truck: Year/Make/Model
Engine
Transmission
Sleeper
Serial Number
Condition
Title State
Payment Amount
Amount Still Owed
Other Information

Trailer: Year/Make/Model
Dimensions Length; Width; Height
Serial Number
Condition
Title State
Payment Amount
Amount Still Owed
Other Information

Disclosure
I certify that the information stated in this application is true and correct to the best of my knowledge. I further certify that the vehicles leased/financed from you will be used exclusively for business or commercial purposes. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit with credit reporting agencies and other sources and employment history and to answer questions about your credit experience with me.
Signed By
Date